CAJ | 학술논문

目的探讨不同浓度罗哌卡因用于臂丛神经感觉与运动分离阻滞的效果.方法择期上肢手术患者90例,ASA分级Ⅰ～Ⅲ级,年龄16～75岁,体重40～85 kg.均在超声引导联合神经刺激器辅助定位下行腋路臂丛神经阻滞,根据不同罗哌卡因浓度分为3组(n=30):0.15%罗哌卡因组(A组),0.10%罗哌卡因组(B组),0.05%罗哌卡因组(C组).于注射局麻药后10、30、60、240 min(T1～4)时记录感觉与运动分离阻滞情况、感觉阻滞完善情况和臂丛神经阻滞成功情况,术毕时评定麻醉效果.记录手术时间、镇痛时间.结果与A组比较,B组T1.2时感觉阻滞完善率较低(P＜0.05),T3.4时感觉阻滞完善率差异无统计学意义(P＞0.05),感觉与运动分离阻滞率较高(P＜0.01),C组T1.2时感觉与运动分离阻滞率较低(P＜0.01),T3.4时感觉与运动分离阻滞率差异无统计学意义(P＞0.05),各时点感觉阻滞完善率较低(P＜0.01).与B组比较,C组各时点感觉阻滞完善率、感觉与运动分离阻滞率均较低(P＜0.01).A组麻醉效果优于B组,B组麻醉效果优于C组(P＜0.01),与A组和B组比较,C组臂丛神经阻滞成功率较低(P＜0.01),A组与B组差异无统计学意义(P＞0.05).结论 0.10%罗哌卡因用于臂丛神经阻滞可产生感觉与运动分离阻滞效果.
목적 탐토불동농도라고잡인용우비총신경감각여운동분리조체적효과.방법 택기상지수술환자90례,ASA분급Ⅰ～Ⅲ급,년령16～75세,체중40～85 kg.균재초성인도연합신경자격기보조정위하행액로비총신경조체,근거불동라고잡인농도분위3조(n=30):0.15%라고잡인조(A조),0.10%라고잡인조(B조),0.05%라고잡인조(C조).우주사국마약후10、30、60、240 min(T1～4)시기록감각여운동분리조체정황、감각조체완선정황화비총신경조체성공정황,술필시평정마취효과.기록수술시간、진통시간.결과 여A조비교,B조T1.2시감각조체완선솔교저(P＜0.05),T3.4시감각조체완선솔차이무통계학의의(P＞0.05),감각여운동분리조체솔교고(P＜0.01),C조T1.2시감각여운동분리조체솔교저(P＜0.01),T3.4시감각여운동분리조체솔차이무통계학의의(P＞0.05),각시점감각조체완선솔교저(P＜0.01).여B조비교,C조각시점감각조체완선솔、감각여운동분리조체솔균교저(P＜0.01).A조마취효과우우B조,B조마취효과우우C조(P＜0.01),여A조화B조비교,C조비총신경조체성공솔교저(P＜0.01),A조여B조차이무통계학의의(P＞0.05).결론 0.10%라고잡인용우비총신경조체가산생감각여운동분리조체효과.
Objective To determine the appropriate concentration of ropivacaine for differential sensory and motor block of brachial plexus.Methods Ninety ASA Ⅰ - Ⅲ patients aged 16-75 yr weighing 40-85 kg undergoing upper extremity operation under axillary brachial plexus block were randomly divided into 3 groups according to the concentration of ropivacaine used for the block(n = 30 each): group A 0.15% ropivacaine;group B 0.10% ropivacaine and group C 0.05% ropivacaine.Axillary brachial plexus block was performed using ultrasound guidance and electric nerve stimulation.Sensory and motor block were assessed and recorded at 10,30,60and 240 min after local anesthetic injection(T1-4).The rate of adequate sensory block,the rate of differential sensory and motor block(the areas innervated by radial,median and ulnar nerves were numb but the patients could still move their elbow,wrist and fingers)and effectiveness of the block(excellent - completely no pain;good slight pain,iv fentanyl was needed;poor -rescue brachial plexus block was needed or general anesthesia was induced).Operation time and duration of analgesia and success rate of the block were recorded.Results 0.15%ropivacaine produced excellent or good block and no failure in group A.The rate of differential sensory and motor block was significantly higher in group B(0.10% ropivacaine)than in group A.The effect of block with 0.05% ropivacaine was unsatisfactory in group C.Conclusion Axillary brachial plexus block with 0.10% ropivacaine can induce differential sensory and motor block in the majority of patients.